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Native American Communities and Mental Health

Mental Health America works nationally and locally to raise awareness about mental health and ensures that those at-risk for mental illnesses and related disorders receive proper, timely and effective treatment. MHA incorporates culturally competent strategies to ensure that it is effectively addressing the treatment and psychosocial needs of consumers and families with diverse values, beliefs, sexual orientations, and backgrounds that vary by race, ethnicity and/or language.

Statistics

The following statistics were taken from the “Mental Health: Culture, Race and Ethnicity Supplement” to the 1999 U.S.Surgeon General’s Report on Mental Health.

Demographics/Societal Issues

Approximately 1.5% of the U.S. population, or roughly 4.1 million Americans, identify themselves as having Native American or Alaska Native heritage.

Most Native Americans live in Western states, with 42% in rural areas compared to 23% of whites. Twenty percent live on reservations today. Over 50% now live in urban, suburban, or rural non-reservation areas.

Native Americans speak over 200 indigenous languages. Approximately 280,000 speak a language other than English at home; more than half of Alaska Natives who are Eskimos speak either Inuit or Yup'ik.

Sixty-six percent of Native Americans 25-years-old and over have graduated from high school, but it is below the 75% rate for the U.S. as a whole. In 1998, Native American men and women were roughly twice as likely as whites to be unemployed. In 1999, about 26% of Native Americans lived in poverty, compared to 13% for the United States as a whole and 8% of non-Hispanic, white Americans.

Native Americans are over-represented among people who are homeless. While representing less than 2% of the U.S. population, it is estimated that Native Americans constitute 8% of homeless Americans.

Historically, Native Americans were over-represented among children in foster care. Until 1978, when Congress passed the Indian Child Welfare Act to end "a pattern of discrimination against American Indians," an estimated 25% to 30% of Native American children had been removed from their families. By 1999, Native American children accounted for only 1% of children in foster care.

Attitudes

There have not been many studies about Native American attitudes regarding mental health and mental illness. There is a general Native American worldview that encompasses the notions of connectedness, reciprocity, balance and completeness that frames their views of health and well-being. Studying this experience may help lead to the rediscovery of the fundamental aspects of psychological and social well-being and the mechanisms for their maintenance.

Prevalence

Larger-scale studies of mental disorders among older Native Americans are lacking, but smaller studies have found rates of depression ranging from 10% to 30%.

The prevalence rate for suicide among Native Americans is 1.5 times the national rate. Males aged 15-24 account for two-thirds of all Native American suicides.

The estimated rate of alcohol-related deaths for Native Americans as a whole is much higher than it is for the general population.

In 1997, an estimated 1 out of every 25 Native American adults was in the criminal justice system. A 1998 study found that 1 out of every 2 adolescents in a Northern Plains reservation juvenile detention facility had a substance abuse or mental health disorder. Many of these young people had multiple disorders.

Treatment Issues

Representative community studies of Native Americans have not been published, so little is known about the use of mental health services among those with established need. Smaller studies have found that 32% of Native American adults with a mental disorder received mental health or substance abuse services, about the same as the U.S. population as a whole.

Among Cherokee children with a mental disorder, only 1 in 7 received professional mental health treatment, a rate similar to the non-Native American sample. Cherokee children were more likely than white children to receive treatment through the juvenile justice system and inpatient facilities.

Native Americans appear to use alternative therapies at rates equal to or greater than whites.

Few Native Americans have been included in the controlled clinical trials used to develop treatment guidelines for the major mental disorders.

Access/Insurance

The Indian Health Service is the federal agency responsible for providing health services to native populations. However, only 20% of Native Americans report accessing those clinics, which are located mainly on reservations.

Medicaid is the primary insurer for 25% of Native Americans and only about 50% of Native Americans have employer-based health insurance, compared to 72% of whites. Twenty-four percent of Native Americans do not have health insurance, compared to 16% of the U.S. population.